Background: Several studies have implicated a role of inflammation in the pathogenesis of lung damage in idiopathic pulmonary fibrosis (IPF). Parenchymal lung damage leads to defects in mechanics and gas exchange and clinically manifests with exertional dyspnea. Investigations of inflammatory cells in IPF have shown that eosinophils, neutrophils and CD 8+ TLs may be associated with worse prognosis. We wished to investigate by quantitative immunohistochemistry infiltrating macrophages, neutrophils and T lymphocytes (TLs) subpopulations (CD 3+ , CD 4+ and CD 8+ ) in lung tissue of patients with IPF and their correlation with lung function indices and grade of dyspnoea.

Lung MZCL associated with pSs are characterized by an important dissociation between clinical expression and radiological pattern. Clinical presentation and imaging features are not specific. Therefore, histologic documentation is mandatory to ensure diagnosis. Various chemotherapeutic agents in combination with rituximab lead to partial or complete remission in the majority of patients.

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A 33-yr-old, Caucasian male, smoker (40 pack-yr) presented to the current authors9 hospital complaining of a painful and swollen right breast, which had already lasted a few weeks. He had poor oral hygiene, had been subject to several teeth extractions over the previous 2 yrs and had sporadically used oral antibiotics. He denied fever, cough and shortness of breath or weight loss. The chest physical examination disclosed a painful large soft tissue mass (1068 cm) on the anterior right side of the chest wall, right in the upper part of the breast.Vital signs were normal, as were the results of the routine laboratory tests, with the exception of the erythrocyte sedimentation rate and the C-reactive protein, which were both elevated. The arterial blood gas analysis was within the normal range. The tuberculosis skin test was negative. The patient9s chest radiograph and the computed tomography (CT) scan are shown in figures 1 and 2, respectively. A surgical biopsy was performed under local anesthesia and the tissue histology is also shown in figure 3.

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A 65-yr-old male, current smoker of .30 cigarettes?day -1 (total smoking history 150 pack-yrs), who was working as a bus driver, presented at the Evangelismos Hospital (Athens, Greece) complaining of increasing breathlessness on exertion and dry cough during the past 2 months. He had no animal exposure and he hadn't travelled abroad during the last few years. His medical history showed arterial hypertension, for which he was receiving treatment with an angiotension-converting enzymeinhibitor (ramipril) plus hydrochlorothiazide, as well as asymptomatic cholelithiasis and prostate hypertrophy for which he was receiving tamsulosin hydrochloride. He did not mention suffering from fever in the last few months.On admission, the patient was mildly tachypnoeic (22 breaths? min -1 ), but apparently in discrete health, with a body temperature of 36.8˚C, pulse rate 85 beats?min -1 and blood pressure 130/70 mmHg. On chest auscultation, rare fine inspiratory rales were audible over both hemithoraces. He had no clubbing. The tuberculin test was negative. The routine blood analysis and chemistry was normal. Arterial blood gas analysis while breathing room air gave results as follows: arterial oxygen tension (Pa,O 2 ) 7.95 kPa; carbon dioxide arterial tension (Pa,CO 2 ) 3.94 kPa; pH: 7.45. Chest radiography on admission is shown in figure 1. Spirometry 2 days later was compatible with a moderate restrictive pattern (forced vital capacity (FVC): 1.52 L (48% predicted); forced expiratory volume in one second (FEV1): 1.28 L?sec -1 (53.6% pred); FEV1/FVC6100 ratio: 84%). Lung volumes and diffusing capacity could not be assessed because the patient was unable to cooperate. A bronchoscopy was performed on the 4th day of hospitalisation and no endobronchial abnormalities were found. Bronchoalveolar lavage (BAL) was performed during bronchoscopy and the total cell count was 26.6610, with a differential of 82% macrophages, 12% lymphocytes and 6% neutrophils. No infective agents were detected in sputum or in bronchial secretions. Serology for HIV infection was negative, as was the urinary test for Legionella pneumophila and Streptococcus pneumoniae. Serology for common virus, and mycoplasma, ricketsiae and chlamydiae were pending. No underlying immunosuppressive condition was evident.During the 2-3 days following bronchoscopy, the patient's respiratory condition rapidly deteriorated. Respiratory rate was 34 breaths?min -1 and pulse rate 130 beats?min -1 . Arterial blood gases on supplemental oxygen and fractional concentration of oxygen in inspired gas 60% were: Pa,O 2 9.24 kPa; Pa,CO 2 4.2 kPa; pH 7.44. However, he remained afebrile and the new haematology and biochemical laboratory studies, including total and differential white cell blood count, were within the normal range.Another chest radiograph obtained on the 7th day of his hospital stay, is shown in figure 2, and the chest computed tomography (CT) obtained at the same time point is shown in figure 3. During the next few hours, the patient was admitted to the intensive care unit ...

A 63-yr-old male presented with a 20-day history of fever with chills, rigors, sweats and fatigue. He resided in the countryside and there was no history of recent travel to other countries. He had a past medical history of idiopathic pulmonary fibrosis (usual interstitial pneumonia confirmed by surgical biopsy) and the last 2 yrs he was taking daily azathioprine 100 mg per os and methylprednisolone (actually) 12 mg per os.On physical examination he was pale, with a body temperature of 39.5uC, blood pressure 130/90 mmHg, pulse rate 90 beats per min and respiratory rate 24 breaths per min. There were no skin rashes, petechiae or ecchymoses. The abdomen was soft, without tenderness or rigidity and the spleen was enlarged 3 cm below the costal margin. The auscultation revealed "velcro" rales at the lower lung fields bilaterally. There were no heart murmurs.Laboratory . Peripheral blood smear showed no parasites. Cultures of blood and urine failed to yield any significant growth, and induced sputum was negative for Pneumocystis carinii. Mantoux and sputum test for acid-fast bacilli were negative. Serology for human immunodeficiency virus (HIV) and urine Legionnella antigen were negative, while the results of serological tests for mycoplasma, chlamydia, ricketsiae, malaria, leishmania, brucellosis and common virus were pending.Chest roentgenogram ( fig. 1a) and computed tomography scan have shown no apparent changes compared with past films (12 months previous). An upper abdomen film is visible in figure 1b.A bone marrow aspirate was performed; the findings are shown in figure 2.